The title of the game is very misleading in that the gameplay has little to do with Tetris. Instead, square panels rise from the bottom (called the "stack") and the job of the player is to line up three or more matching panels either horizontally or vertically as the stack rises.

The player controls the panels using a rectangular cursor on the screen which the player uses to switch the selected panels back and forth. Extra points are given for combinations of more than three. If the stack touches the top of the playing field while rising, the game is over.

In Endless mode, players play to try to achieve the best possible score before they get a game over. Players can choose the difficulty level (Easy, Normal, Hard) and the speed level (lv. 1-99) to start out. However, the longer they manage to stay alive, the faster the stack will start to rise. If the player manages to reach a score of 99,999, the credits sequence will play.

This mode is just like the Endless mode (see above), except players must clear all the panels above the "clear line" that's drawn in the stack. The line is not visible at the beginning of the game, and is only visible when players have cleared enough panels for the stack to rise enough. If the stack touches the top before all the panels above the "clear line" are removed, the players will lose. There's no time limit in this game mode.

There's a total of 30 rounds (not counting the "special stage" and "last stage"), with five rounds per level.

The "special stage" and "last stage" involve defeating Bowser with combos and chains before the stack reaches the very top. While the "special stage" is only a bonus stage to test the players' skills, the "last stage" can be repeated if they lose.

In the puzzle mode, players are given a number of panels on the screen, and they must clear all of them with only a limited number of switches by the cursor. Players play ten rounds with up to six different characters. Also, at the end of each round, players are given a password, which they can use to come back to their game at a later time. There is no time limit for this game mode.

On a side note, there are some even more difficult puzzles that players can play with if they have the proper password.

Single player VS is a game where players can battle the computer in a fight to free the players' allies from a spell cast by Kamek. One by one, the players and Yoshi must break the spell over each of their allies by battling and defeating them. The key to doing that is to dump Garbage Blocks, which resemble the Evil Ceiling from Wario's Woods, on their stack. There are special panels called Shock Panels. When three or more of these align, this creates a Shock Block, a special Garbage Block, which makes clearing Garbage Blocks more difficult. Each battle gets successively more difficult, and as the players progress and free their allies, they can use them in battle as well.

Inside Mt. Wickedness, the players will face off against Hookbill the Koopa and Naval Piranha on all the skill levels. On the "Normal" and "Hard" skill levels, Kamek will be the next opponent. And on the "Hard" skill level, the players will face Bowser as the final opponent.

There's also a "Super Hard" skill level, which will heavily test the players' skills. All opponents fought on the "Hard" skill level will be in this skill level.

While Mario, Luigi, Princess Peach, and Toad do not make a direct appearance in this game, Yoshi fights against Bowser and rescues his friends in the game's single-player versus mode, and he explains the gameplay to the player in the tutorials. A multitude of other characters from Super Mario World 2: Yoshi's Island appear in the game as well, some as allies and some as enemies. The following characters are:

Upon turning on the SNES, press the following buttons; , , , . If done correctly, the player will hear a chime. When the player does a one-player game mode, the stack will not stop, regardless of if the player does a combo or chain.

In the 1P VS mode, the player can play the "Super Hard" skill level by pressing D-Pad Up, , and at the same time while the "Hard" skill level is selected. If done correctly, the lower background will turn dark red. The dark red background is a sign that the player is playing on the "Super Hard" skill level.

Players can use the rival characters in the 2P game modes by doing the following; player 1 and player 2 must hold the and buttons at the same time while on the character select screen. If done right, the "? panels" will change into the rival characters.

When the Game Boy version is played on a Super Game Boy, there are six secret borders that can be selected via button codes at the title screen, when selecting "1P" to play the game. They are:

Yoshi stage border

Gargantua Blargg stage border

Poochy stage border

Froggy stage border

Lakitu stage border

Raphael the Raven stage border

The player can return to the title screen at any time to choose another border. Pressing just on the title screen will make the border the default star border again, while pressing the button will keep the current border.

The SNES version of the game does feature an "Options" menu, which enables the player to change the language settings, listen to sound effects and background music, and even view data about the characters.

There's also a "CPU Switch" feature, in which player 1 and/or player 2 will be controlled by a CPU player. However, this feature can't be used to view game endings in the single player game modes; if attempted, the player will get a message stating that the CPU Switch must be turned off to view the ending.

Originally, Tetris Attack was Panel de Pon, released for the Super Famicom on October 27, 1995, starring a young fairy known as Lip. However, the game didn't actually make it to the West as-is. For the Western release, Nintendo changed all the characters to Yoshicharacters and enemies and renamed it.

Aside from the Yoshi motif, there were other gameplay changes, such as a password system for the story mode and Garbage Blocks were not customized for each character, unlike Panel de Pon.[3]

The Japanese version of Tetris Attack was released on the Satellaview without the Tetris name license. This version was a Japanese localization of the rebranded Panel de Pon with Yoshi characters. There was also an option in the menus to play the game with the characters and story dialogue in English, but the menus would stay in Japanese. The Game Boy version was also released in Japan as a standard cartridge.

Later, Nintendo attempted on releasing a remake of this game as part of the Nintendo Puzzle Collection along with Yoshi's Cookie and Dr. Mario. However, Nintendo Puzzle Collection also ended up being canceled in all countries outside Asia and it became a Japan-only game.

The game was rebranded again, from Tetris Attack, as Puzzle League, now the permanent name for the style of gameplay, and released on a two-game cartridge, called Dr. Mario & Puzzle League, released internationally.